15600 vs 15620


Ashland, MA
Best answers
Hello, the MD thinks this should be coded as 15600 as the flap came from the trunk. I think it should be coded as 15620 as the flap was for the hand (with modifiers 58 & LT). Please let me know your thoughts. Thank you!

PREOPERATIVE DIAGNOSIS: Status post groin flap, left hand.
POSTOPERATIVE DIAGNOSIS: Status post groin flap, left hand.
PROCEDURE: Flap division and insetting, left hand.
INDICATIONS: This is a planned return to the global period following groin
flap coverage of an extensive wound over the dorsum of the left hand.
Risks of surgery including, but not limited to infection, nerve damage,
stiffness, cosmetic deformity, flap failure, donor site morbidity, and need
for further surgery were explained to the patient preoperatively who wished
to proceed.
DESCRIPTION OF THE PROCEDURE: Following adequate anesthesia, the patient
was placed in supine position on the operating table. The sutures that had
been placed between the thenar and hypothenar eminence and the abdominal
skin were removed. There was superficial ulceration, 2 small areas above
the donor scar. The volar and dorsal forearm sutures were removed, leaving
the flap sutures intact. The left upper extremity and groin area were
prepped and draped in sterile fashion. Electrocautery was used to divide
the flap pedicle after clamping the pedicle confirmed proper vascularity to
the flap. The base of the pedicle was trimmed at the level of the groin.
The wound was irrigated copiously. The subcutaneous tissue was
approximated with 3-0 Vicryl interrupted sutures and the skin with 3-0
nylon interrupted sutures. The recipient site tubes pedicle was trimmed
and then inset into the skin at the distal edge of the wound using 3-0
nylon interrupted sutures were care to avoid undermining flap. The flap
remained well perfused. Sterile dressings were applied. The patient
tolerated the procedure well and was discharged to the recovery room in
good condition.


Best answers
The discussion paragraphs for the section on Flaps (Skin and/or Deep Tissues) in the CPT book say that "The regions listed refer to the recipient area (not the donor site) when a flap is being attached in a transfer or to a final site." Based on your scenario, the flap was to the hand from the trunk/groin. The final/staged procedure was to release the flap from the groin, so the correct code would be 15620 for sectioning/releasing the flap.

I hope this helps.

Respectfully submitted, Alan Pechacek, M.D.